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    The Importance of Being Tested / La importancia de la prueba

    By Keith R | July 10, 2007

    Topics: Health Issues | No Comments »

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    ad from Brazilian AIDS testing campaignDid you know that 27 June was HIV Test Awareness Day? I confess that I didn’t. But I had wondered why I am suddenly seeing some many television ads these past two weeks about the importance of getting tested, and why Tyra Banks decided to get tested on her syndicated TV show (no, I don’t watch her show — I just saw the commercials for it).

    I wonder if the media and health authorities have been equally active in Latin America and the Caribbean (LAC). According to the Pan American Health Organization (PAHO), they are. I’d be interested in hearing from readers in LAC about whether they have matched their promises with visible action.

    In my first “Basics” piece, I argued that good diagnosis is usually a prerequisite for good environmental policy. The same holds true of health policy. It is difficult for LAC governments to plan, design, budget and implement adequate public health programs to address HIV/AIDS in their countries if they can only guess at the infection levels/profiles in their populace.

    For example, if you ask WHO or PAHO or UNAIDS how many people in LAC received AIDS treatments in 2006, they will respond that the estimates range from 55% to 95% (yes, estimates, not records). Given what I read from NGOs in the field in LAC dealing with HIV/AIDS patients, the latter figure is simply absurd. Some might even question the 55% estimate as well, particularly outside of Brazil.

    Pregnant women tested for HIV vs. those treated in select countries (click to enlarge) (data: WHO/UNAIDS/UNICEF)This gives you an idea of the uncertainty in LAC statistics regarding HIV/AIDS. If you ask about how many people have been tested, they’ll give you estimates of absolute numbers — but will shy from estimating what percentage of the population at risk this represents.

    Then there’s the individual level. If you have engaged in risky sexual behavior, have a partner you’re unsure of, want to reassure your current or prospective partner, or have received a blood transfusion you have nagging questions about, you only have two basic choices: test and know, or wait and pray.

    I agree with health officials that it’s better to get tested. If you are not infected, it will be a relief to know that. If you are infected, the earlier you find out the better, since that leaves you with more potential treatment options. And of course there’s the consideration of others you might unwittingly infect.

    The ad depicted at the start of this post, which appears in an innovative Brazilian media campaign profiled in PAHO’s Perspectives in Health magazine (English, Spanish), represents the enormous emotional burden one can carry around when you don’t know whether or not you are infected with HIV.

    As the PAHO releases copied below mention, until recently not nearly enough testing was done in LAC nations. This is in part due to the lack of availability of the right diagnostics — many public clinics did not offer it. Reportedly Brazil, El Salvador and Mexico have finally addressed fully the public clinic testing problem, but many of their neighbors have far to go yet.

    Another factor was cost of both diagnostics and treatments (after all, some reasoned, why spend money on diagnosis when you cannot treat?), although this is coming down, particularly with the help of initiatives such as the Clinton Foundation’s.

    A third factor was the social stigma (including workplace discrimination) about anything to do with HIV/AIDS which is still very much alive in many LAC nations. This too is changing, albeit slowly.

    The new media campaigns across the region are intended to change attitudes and diminish reluctance/fear about HIV testing and asking your partners to get tested, particularly among the young. The AIDS epidemic in LAC will prove difficult to roll back until that happens.

    — Keith R


    From the Pan American Health Organization (PAHO):

    The HIV Test: What You Know Can Help You

    On HIV Test Awareness Day, PAHO member countries are spreading the message that knowing one’s HIV status is the first step in prevention, treatment, and care

    Countries throughout the Americas are launching public outreach efforts today urging their citizens to get tested for the human immunodeficiency virus (HIV) as the first step in prevention, treatment, and care for HIV/AIDS.

    The campaigns—part of ongoing efforts to promote HIV testing and counseling among the public—are being launched today in observance of HIV Test Awareness Day, June 27. Started in the United States in 1994 by the National Association of People with AIDS (NAPWA), HIV Test Awareness Day is now observed by countries around the world.

    Not knowing one’s HIV status is among the main factors in the spread of the AIDS epidemic. In Latin America, an estimated 1.7 million people carry the virus, but more than two-thirds are unaware of it. Those who don’t know they carry the virus do not know that they may need life-saving drugs. Worse, they may inadvertently transmit the virus to others.

    In contrast, people who get tested and learn they are HIV-positive can seek treatment to control the virus’s progression. Those who learn they are HIV-negative have extra motivation to protect their HIV-free status.

    Testing for HIV has become more widely available and less costly in Latin America and the Caribbean in recent years, and growing numbers of people are taking advantage of the test. The Pan American Health Organization (PAHO) estimates that more than 700,000 people in the region were tested in 2005 and more than 1 million in 2006. The numbers are expected to be even higher this year.

    Among the reasons behind the growing numbers is the increasing availability of antiretroviral treatment, which allows people with HIV to lead long and healthy lives, as well as the diminished stigma against people living with the virus. Public health officials are also trying to spread the message that more people need to get tested in order to control and eventually halt the epidemic.

    Until recently, many countries struggled just to make HIV testing widely available in their health centers. Countries that have achieved that goal—including Brazil, El Salvador, Mexico, and others—are now trying to boost demand for the tests.

    To do so, they are mounting “Know Your Status” campaigns, which try to motivate men and women, especially the young, to get tested for HIV. The campaigns also tackle such obstacles as difficult access to health services, lack of confidence in the health care system, and fear of discrimination in the workplace or among family and friends.

    Desde la Organizacion Panamericana de Salud (OPS):

    La prueba del VIH: lo que usted sabe puede ayudarlo

    Hoy, Día de Concientización sobre la Prueba del VIH, los países miembros de la OPS están divulgando el mensaje de que si una persona sabe cuál es su estado en cuanto al VIH ya ha dado el primer paso para la prevención, el tratamiento y la atención

    Los países de las Américas están iniciando actividades destinadas al público con el fin de alentarlo a que se someta a las pruebas de detección del virus de la inmunodeficiencia humana (VIH), como primer paso para impulsar la prevención, el tratamiento y la atención del VIH/sida.

    Las campañas —que forman parte de las iniciativas en curso para promover las pruebas y el asesoramiento sobre el VIH entre el público— se están iniciando hoy, 27 de junio, en conmemoración del Día de Concientización sobre la Prueba del VIH. Este Día, iniciado en los Estados Unidos en 1994 por la Asociación Nacional de Personas con Sida (NAPWA, por sus siglas en inglés), se conmemora actualmente en numerosos países.

    El desconocimiento del estado de una persona en cuanto al VIH es uno de los principales factores que influyen en la propagación de la epidemia de sida. Se calcula que en América Latina cerca de 1,7 millones de personas están infectadas con el virus y más de dos terceras partes de ellas no lo saben. Quienes no saben que están infectados tampoco saben que tal vez necesiten medicamentos para salvarles la vida. Lo que es peor aun, esas personas pueden, sin saberlo, transmitir el virus a otros.

    Por el contrario, las personas que se someten a las pruebas de detección del virus y se enteran de que son positivas al VIH pueden buscar tratamiento para controlar el avance de la infección. Los que se enteran de que su prueba fue negativa tienen una motivación más para protegerse y mantenerse libres de la infección por el VIH.

    En años recientes, en América Latina y el Caribe, ha aumentado la disponibilidad de las pruebas de detección del VIH y su costo ha disminuido; por ende, un número cada vez mayor de personas se están sometiendo a las pruebas. La Organización Panamericana de la Salud (OPS) calcula que en 2005, en la región, más de 700.000 personas se hicieron las pruebas y que en 2006 esta cifra fue superior a 1 millón. Se prevé que estas cifras sean todavía más altas este año.

    Entre las razones que contribuyen al aumento de estas cifras se encuentran la mayor disponibilidad de los tratamientos con antirretrovíricos, lo que permite a las personas infectadas con el virus vivir más tiempo y con buena salud; además ha disminuido el estigma contra las personas que viven con el virus. Por otra parte, los funcionarios de salud pública están tratando de divulgar el mensaje de que es necesario aumentar el número de personas que se hacen la prueba para poder controlar y finalmente detener la epidemia.

    Hasta hace poco, muchos países se esforzaban para que las pruebas para el VIH pudieran hacerse a numerosas personas en sus centros de salud. Los países que han logrado esa meta — Brasil, El Salvador, México y otros — ahora están tratando de impulsar la demanda de las pruebas.

    Para hacerlo, están lanzando campañas con el lema “Hazte la prueba”, que tratan de motivar a hombres y mujeres, especialmente a los jóvenes, para que se hagan la prueba para el VIH. Las campañas también abordan obstáculos tales como dificultad de acceso a los servicios de salud, falta de confianza en el sistema de atención de salud, y temor de discriminación en el lugar de trabajo o entre la familia y los amigos.

    La fecha también estuvo marcada por el lanzamiento de un nuevo sitio en Internet, que contiene información sobre experiencias en la promoción de la prueba para el VIH en América Latina e incluye estrategias, guías, campañas y materiales impresos y audiovisuales. El sitio lo administra Comunicación Positiva, una organización de la sociedad civil formada por personas con VIH y por defensores de la causa.

    La prueba del VIH es también el tema del Tercer Premio Latinoamericano de Periodismo. Este concurso lo convocan Red-Salud, una red de periodistas, medios, fuentes y organizaciones civiles, con el apoyo de la OPS, la Iniciativa de Comunicación y la Fundación Nuevo Periodismo Iberoamericano.

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